1. TEACHINGHOW THE PATIENTS’ PARTICIPATION CAN IMPROVE CAN IMPROVE THEIR MEDICAL CARE EXPERIENCE WITH COLLEGE STUDENTS IN A LATIN COUNTRY TEACHINGHOW THE PATIENTS’ PARTICIPATION CAN IMPROVE CAN IMPROVE THEIR MEDICAL CARE EXPERIENCE WITH COLLEGE STUDENTS IN A LATIN COUNTRY Ximena Paez Universidad de los Andes, School of Medicine Merida, Venezuela Ximena Paez Universidad de los Andes, School of Medicine Merida, Venezuela

2. “The MORE you know United Health Foundation The HEALTHIER you will be”

3. 1.Introduction 2.Methods 3.Results 4.Conclusions

4. How to get the most out of a visit to the doctor’s office Educating the patients, 1. Introduction

5. The most important member of the health care team is The PATIENT !!!! So, TEACHING HOW, Take charge of HIS or HER OWN care Take charge of HIS or HER OWN care to obtain the most of the medical care to obtain the most of the medical care TEACHING THAT,

6. These are new concepts, broadly and intensively diffused in developed countries broadly and intensively diffused in developed countries after of the report: “Err is Human” Institute of Medicine 1999 The remarkable results showed that the patient safety was really compromised in american hospitals!!

7. More deaths by medical errors than by: Car accidents !! Breast cancer !! or AIDS !!

8. And if THIS happens in countries, WHERE, WHERE, the patients are used to get the best in medical care !!

9. HOW the situation could be in the poor, undeveloped countries, like most Latin countries ? HOW the situation could be in the poor, undeveloped countries, like most Latin countries ?

10. Problably, much worse much worse because of, 1. The untouched traditional paternalist view of the doctor-patient relationship: * PATIENTS accept the illness as part of their destiny They do not ever dare the doctors with questions And * DOCTORS do not ever expect to be questioned by patients

11. 2. The medical care is deficient and deteriorated, result of many complex factors, economical, educational, political and cultural ones. So, Our patients totally ignore, that their participation in his or her health care is determinant in the outcome, independently of his or her educational level

12. How could this situation be changed?

13. By EDUCATING the patients in health topics !!! How to be a well informed patient, that can take wise decisions in that can take wise decisions in their own medical care How doctors and patients How doctors and patients working together will benefit both !!!

14. Purpose : To teach the new concepts about the participation To teach the new concepts about the participation of the patients in their medical care, to of the patients in their medical care, to college students, to prepare them to obtain college students, to prepare them to obtain a better medical care a better medical care

15. 2. Methods Subjects: Male and female second year college students from medical and engineering schools (n= 35) Instrument: An informal short seminar with topics such as: proper patient-doctors relationship, patient’s rights, informed consent, medical error and its management, local legislations, etc. Using selected reading of some documents such as, Hippocrates Oath, Declaration of Human Rights, Carte of Patients Rights, and local laws. Discussion of medical cases in the community Socio-dramas of some local medical cases Reanalysis of the cases at the end of the course Analysis: Evaluation of the students’ opinion at the end through a simple questioner 2. Methods Subjects: Male and female second year college students from medical and engineering schools (n= 35) Instrument: An informal short seminar with topics such as: proper patient-doctors relationship, patient’s rights, informed consent, medical error and its management, local legislations, etc. Using selected reading of some documents such as, Hippocrates Oath, Declaration of Human Rights, Carte of Patients Rights, and local laws. Discussion of medical cases in the community Socio-dramas of some local medical cases Reanalysis of the cases at the end of the course Analysis: Evaluation of the students’ opinion at the end through a simple questioner

16. This simple course was appealing and changed the initial views and attitudes of all students independently of their careers !!!. This simple course was appealing and changed the initial views and attitudes of all students independently of their careers !!!. 3. Results Here, there are some of the students opinions to the following questions Here, there are some of the students opinions to the following questions

17. 1. Is your opinion, about how the patient-doctor relationship should be, the same now than before the seminar? the same now than before the seminar? 2. Has your opinion, about the role of the patients in their medical care, changed? Why? 3. Do you think that the discussed issues could be useful for you from now on? from now on? 4. What was the most interesting new issue for you? Would you recommend to repeat this type of seminar to others? Would you recommend to repeat this type of seminar to others? 1. Is your opinion, about how the patient-doctor relationship should be, the same now than before the seminar? the same now than before the seminar? 2. Has your opinion, about the role of the patients in their medical care, changed? Why? 3. Do you think that the discussed issues could be useful for you from now on? from now on? 4. What was the most interesting new issue for you? Would you recommend to repeat this type of seminar to others? Would you recommend to repeat this type of seminar to others?

18. 1.Is your opinion,about how the patient-doctor relationship should be, the same now than before the seminar? All the students said they have a different opinion now. They were surprised they can have rights as patients, but they easily understood that if they know their rights they can ask for a better attention, and that a good doctor-patient relationship is associated with a better medical care. All the students said they have a different opinion now. They were surprised they can have rights as patients, but they easily understood that if they know their rights they can ask for a better attention, and that a good doctor-patient relationship is associated with a better medical care.

19. “Definitively, this seminar has changed my way to understand the relation between doctors and their patients. I learned that the doctor is not a genius between doctors and their patients. I learned that the doctor is not a genius that knows exactly what the patient may have and that he o she is simply a person that can make mistakes as anybody else” a person that can make mistakes as anybody else” “Besides, I learned that the physician cannot guess what the patient has if the patient does not tell him sincerely what he or she feels.” if the patient does not tell him sincerely what he or she feels.” “I also understood that in the relation between doctors and patients each one “I also understood that in the relation between doctors and patients each one has rights and responsibilities and that the most important part must be has rights and responsibilities and that the most important part must be the health of the patient” the health of the patient” “We must ask more of the medical care but we should also improve as patients” improve as patients” “I know better my rights and I can ask for more information, so I can follow well the doctor’s instructions. In this way, we mutually get benefits, the doctor triumphs professionally and I can get more from his o her knowledge”

20. 2. Has your opinion, about the role of the patients in their medical care, changed? Why? 2. Has your opinion, about the role of the patients in their medical care, changed? Why? The result was the same than for the first question. All said that they changed the view they had about the patient’s role. In the beginning they did not have any idea that the patient could have any input in their care, for them the patient’s role was a very passive one. The result was the same than for the first question. All said that they changed the view they had about the patient’s role. In the beginning they did not have any idea that the patient could have any input in their care, for them the patient’s role was a very passive one.

21. “I learned that it is necessary that the patient communicates everything to the doctors in order to the doctors can perform correctly their work, to the doctors in order to the doctors can perform correctly their work, that means reach the adequate diagnostic and treatment and correct that means reach the adequate diagnostic and treatment and correct on time wrong decisions.” on time wrong decisions.” “I have changed my opinion about the patient’s role in the medical care. I am a customer of a service, therefore I deserve an effective, fair and immediate care for my problems and the doctor as a care giver must accomplish his o her role “The patients must be less passive, must not have fear to make questions and interact more with the doctors” “My opinion has changed completely; the patient has the power to influence in his or her own medical service, if he or she communicates openly in his or her own medical service, if he or she communicates openly everything about the disease to the doctor”

22. 3. Do you think that the discussed issues could be useful for you from now on? could be useful for you from now on? 3. Do you think that the discussed issues could be useful for you from now on? could be useful for you from now on? Again the response was uniform in all the students. They believe that the discussions about the issues in the program will be useful for them. Again the response was uniform in all the students. They believe that the discussions about the issues in the program will be useful for them.

23. “Of course, since the discussed cases were real and common in the daily life” “I considered before that the patient should be passive because of the exaggerated respect and distance towards the doctor, but now I know that the relation respect and distance towards the doctor, but now I know that the relation must be of mutual respect and confidence” must be of mutual respect and confidence” “I considered before that the patient should be passive because of the exaggerated respect and distance towards the doctor, but now I know that the relation respect and distance towards the doctor, but now I know that the relation must be of mutual respect and confidence” must be of mutual respect and confidence” “Yes, because we can transmit all that we learned to the persons in our environment” “next time I need medical care it will be much easier, because I will know if what the doctors are doing is right or not and I can ask for my rights” “ …it is a shame that only few people have the information we have now” “We learned things we ignored such as the rights and responsibilities of the patients” “In the beginning, I thought this seminar it was a waste of time, but then, I realized that the discussions were about real life issues and I could see realized that the discussions were about real life issues and I could see the patient-doctor relationship from a different prospective. This will help me to deal with these situations in the future.” “We learned things we ignored such as the rights and responsibilities of the patients” “In the beginning, I thought this seminar it was a waste of time, but then, I realized that the discussions were about real life issues and I could see realized that the discussions were about real life issues and I could see the patient-doctor relationship from a different prospective. This will help me to deal with these situations in the future.”

24. 4. What was the most interesting new issue for you? Would you recommend to repeat this type of Would you recommend to repeat this type of seminar to others? seminar to others? 4. What was the most interesting new issue for you? Would you recommend to repeat this type of Would you recommend to repeat this type of seminar to others? seminar to others? One of the most chocking issues for the majority of the students was the existence of patient’s rights!! Most of them recommended the course should be given to more people, the rest of their classmates, students of other careers and even for the whole community. One of the most chocking issues for the majority of the students was the existence of patient’s rights!! Most of them recommended the course should be given to more people, the rest of their classmates, students of other careers and even for the whole community.

25. “The most interesting was the discussion about the rights and duties of the patients that in our country are ignored” “I think that in general there is very little information about the rights and duties of the patients, doctors and medical institutions” “I also consider that is strictly necessary to teach those topics as essential subject for the medical students” “Many of the things we learn here are unknown for one as well for some doctors. This fact prevents that people can establish a good relationship with the doctors” “For me the most interesting discussion was about the Classical Hippocrates Oath” “I would recommend this seminar for everybody, since the people should know their rights as patients” “We learn something everyday and learning is always useful, the seminar turned to be practical” “We learn something everyday and learning is always useful, the seminar turned to be practical” “The most interesting was the discussion about the rights and duties of the patients that in our country are ignored” “I think that in general there is very little information about the rights and duties of the patients, doctors and medical institutions” “I also consider that is strictly necessary to teach those topics as essential subject for the medical students” “Many of the things we learn here are unknown for one as well for some doctors. This fact prevents that people can establish a good relationship with the doctors” “For me the most interesting discussion was about the Classical Hippocrates Oath” “I would recommend this seminar for everybody, since the people should know their rights as patients” “We learn something everyday and learning is always useful, the seminar turned to be practical” “We learn something everyday and learning is always useful, the seminar turned to be practical”

26. The students’ opinions after the course showed the change in their attitude respect to the preconceptions they had. ~ They expressed they will have an active participation in the next opportunity they need medical care. ~ They also wanted that these teachings they received were mandatory especially for medical students. ~Finally, they voiced the interest in the diffusion of these concepts tothe rest of the community because of their immediate beneficial application. The students’ opinions after the course showed the change in their attitude respect to the preconceptions they had. ~ They expressed they will have an active participation in the next opportunity they need medical care. ~ They also wanted that these teachings they received were mandatory especially for medical students. ~Finally, they voiced the interest in the diffusion of these concepts tothe rest of the community because of their immediate beneficial application.

27. 4.ONCLUSIONS 4. CONCLUSIONS 1. This experience suggested that the public is very receptive to these ideas, and that it is possible that individuals become educated patients. 2. These active patients will demand and watch for a better medical care, even in the precarious existing conditions, with the consequent benefit for patients and doctors. 3. Therefore, institutions and governments should also put emphasis in patient’s education to improve the health care systems. 4.ONCLUSIONS 4. CONCLUSIONS 1. This experience suggested that the public is very receptive to these ideas, and that it is possible that individuals become educated patients. 2. These active patients will demand and watch for a better medical care, even in the precarious existing conditions, with the consequent benefit for patients and doctors. 3. Therefore, institutions and governments should also put emphasis in patient’s education to improve the health care systems.

28. - Venezuela Merida - Venezuela